The Astley Ainslie Hospital – Its past and the future

St. Roque House, 1940.  postcard from the collection of Mrs Anne Stevenson.

Sara Stevenson, September 2018

The National Health Service is about to leave the land occupied by the Astley Ainslie Hospital – a substantial area in South Edinburgh. They are moving all or part of the services devoted to convalescence and the recovery of long-term patients to the site of the Royal Edinburgh Hospital, and building new buildings on the land there. How long this work will take to complete is not yet clear.

The history of the land from the fifteenth to the nineteenth century

The land has a long and fascinating relationship to our health. In the fifteenth or sixteenth century, a chapel was built here dedicated to St Roque – the patron saint of those afflicted by plague. Edinburgh was periodically visited by savage attacks of plague, and the St Roque priest was responsible for the sick who were sent out from the City, and many of them are buried here in the cemetery.

The area has been known as ‘Canaan’, after the Biblical land promised to the Israelites by God, and is, like the original Canaan, a land ‘flowing with milk and honey’. It is part of the Borough Muir, the common land benefitting Edinburgh’s inhabitants in the middle ages, allowing them to cut wood or graze their cattle. By the later eighteenth century it was rich and fertile farmland, filling the ‘immense demand for every species of green crop and grain’ from the city.

In the early nineteenth century, the land was occupied by villas and gardens newly-planted by enthusiastic botanists. Sir Walter Scott, looking down from Blackford Hill, predicted that ‘the trees of these little pleasure-grounds would grow to make the view more beautiful than it has ever been since the remote period when the Borough-Moor was overshadowed by mighty oaks’.

The medical connection continued through the people who lived in the new houses, who included the surgeon, Professor James Syme, and his daughter, Agnes Syme who married Joseph Lister and was his active partner in medical advance. Syme and his wife were enthusiastic gardeners and developed an extraordinary garden, with plants from all over the world, and flourishing pineapples, grapes, figs, peaches and bananas in their greenhouses.

David Ainslie of Costerton

The land of Canaan was bought for public benefit by the Trustees of a major philanthropist, David Ainslie, in the 1920s.

David Ainslie, who had lived near Haddington, was a farmer, breeding Shorthorn cattle and Leicester sheep amongst other animals. In the 1860s he was a leading prizewinner in the agricultural shows, competing with wealthy landlords, like the Duke of Buccleuch and Lord Kinnaird. Ainslie died in 1900, a wealthy man with extensive shares in international railways. He left most of his money, ‘for erecting endowing and maintaining an Hospital or Institution for the relief and behoof [benefit] of the convalescents in the Royal Infirmary of Edinburgh’. The Infirmary itself was a hospital ‘open to all the distressed from whatever corner of the world they come, without restriction’.

Ainslie instructed his Trustees ‘to purchase land to such an extent and in such locality in or near Edinburgh as they may consider fit for the site of “The Astley Ainslie Institution”’ and, he added emphatically, ‘garden and Policy and Recreation Ground for it…’ [David Ainslie’s Testament, Scottish Record Office SCOO7000001-00] Ainslie cautiously advised that the money be invested for some years to increase the capital, and the Institution was not initiated in South Edinburgh until the 1920s. By that time, his Trustees had achieved a capital of about £700,000 (more than £30 million in today’s terms).

Who was John Astley Ainslie?

David Ainslie’s hospital was named in memory of his nephew, John Astley Ainslie.

John was orphaned as a boy. David Ainslie, his uncle, took him in charge and became deeply attached to him. When he was about twelve years old, his uncle commissioned a portrait from a noted animal painter, Gourlay Steele – which shows him sitting on his pony, Fairy. The painting is now in the offices of the Astley Ainslie Hospital. John was clearly athletic. He appears in the newspapers, graduating from Oxford in May 1873, and shooting game in Perthshire in August of that year. Eight months later, he died in Algiers aged only 26. We do not know why.

John had given money to the new Royal Infirmary in 1868, so he shared his uncle’s interest in public health. The Astley Ainslie Hospital is a magnificent memorial to the young man, giving new life and the hope of good recovery to the many thousands who have passed through.

The Astley Ainslie Institution – the early years

In 1920, the Trustees of the Astley Ainslie bought the lands of Canaan – a protected, south-facing site with gardens, several fine nineteenth century houses and a ladies’ golf course. The newspapers reported it that it was ‘one of the most beautiful sites in the South Side of the city, no better could be wished for as a residence for convalescent patients.’

The Trustees employed the architects, Auldjo Jamieson and Arnott, who built the entrance lodges and gates, and provided the scientific block in a pleasing Egyptian style (with a laboratory, dispensary and gymnasium). As their experience grew of the patients’ needs, the Trustees built a school for the child patients, and designed ‘butterfly’ wards with wide verandahs where the bedridden could be wheeled out into fresh air and the light – to see the sky and the hills.

West Pavilion, 1929
West Pavilion, 1929

The Institution, which was later renamed as a hospital, was designed to accommodate patients from the Royal Infirmary, who needed prolonged care to recover – they also took in people who needed to build up strength before operations. They expected that their ‘convalescent’ hospital would be an active element in preventive medicine and said: ‘Our knowledge that recovery is favoured by such factors as change of air, rest, exposure to sunshine, and by certain dietetic and medicinal measures is still to a large extent empirical, and its application is not directed by the same scientific rules as guide the physician in the treatment of the more acute phases of an illness’. [Alexander Miles, convenor of the House and Works Committee for the Astley Ainslie, University of Edinburgh Journal, 1929-30]. The Governors provided a laboratory for developing these ideas. The grounds were laid out by the Royal Botanic Gardens and were planted with extraordinary Himalayan plants. The garden, which is still full of splendid trees, had greenhouses for exotic plants as well as the outdoor gardens for pleasure and the growth of fresh vegetables. Patients would spend much of their time out of doors in these beautiful surroundings.

Ward at Astley Ainslie, 1929

Sheriff Crole, launching this magnificent venture, said: ‘no such institution existed, as the Governors intended that Institution should exist, in Great Britain or even in America. Mr Ainslie’s benefaction was a noble one… the management was entirely independent… Their funds were large.’ [‘Back to Health. New Edinburgh Scheme for the Ashley-Ainslie Institution’] The Institution was a source of national pride.

Bowlers, in the garden laid out by the Royal Botanic Garden, Edinburgh, 1929

The National Health Service

The bequest

After the Second World War, the Government set up the National Health Service and the Astley Ainslie Hospital was taken over. David Ainslie’s impressive bequest was partly absorbed by Act of Parliament into the general funds of the service – David Ainslie has, therefore, supported the NHS for 70 years. However, the NHS Act and the Report of the Commission on the Scottish Hospital Foundations, published in 1955, made serious qualifications. The commission was ‘enjoined to have special regard to the spirit of the intention of the founder… and in particular to conditions intended to preserve the memory of any person’. They singled out the Astley Ainslie. It was the largest endowment in Scotland. After transferring a substantial proportion – 37.5 percent – to other institutions for their support and to the Hospital Endowments Research Trust, they decided that a substantial part, producing an income of £17,700 per annum should be set aside as a development fund in the field of convalescence and rehabilitation. They concluded: ‘We are confident that the special arrangement, which we have made in this instance will bear fruit in the course of time.’

For a time, the NHS maintained the Astley Ainslie grounds on the principles laid down by the Trustees, but by the 1970s, they regarded the gardens as less of a concern, the greenhouses were demolished and the grounds have been maintained rather than professionally gardened.

The NHS kept the distinct Endowments Research Fund until 2004, when they transferred the money and property into the hands of the local Health Boards [Scottish Hospital Trust (Transfer of Property) Regulations 2004], excepting only that ‘if a condition is attached to any donation or bequest, [it should be considered] in accordance with that condition’.

Advances in treatment at the Astley Ainslie

In the course of the institution’s history, the staff and their patients have been responsible for an expanded and developed approach to recuperation. There have been a wide range of rehabilitation services within the hospital for many years, particularly using physiotherapy, occupational therapy, speech and language therapy and psychology, to help patients to reach their greatest potential.  The first school for Occupational Therapy in Scotland was established by a Canadian expert from the University of Toronto, Mabel McNeill McRae, in the 1930s, and was based on the site for some time before transferring to Queen Margaret University.  In 1976, the Rehabilitation Medicine Unit was established, providing a focus for a range of services including impressive work with cardiac, stroke, brain injury, amputee, chronic pain, and the care of elderly patients. In 1992, the impressive Heart Manual was first published.

A state of the art centre was built 12 years ago to provide rehabilitation technology services, including mobility, prosthetic, orthotics, bioengineering, electronic assistive technologies and driving assessment services.  

Thousands of people have been helped to resume their lives, through this essential work; thousands of families and friends have been cheered by their success.

This is the last Scottish hospital devoted to convalescence.

Supporters and Beneficiaries

The Astley Ainslie is supported by the generosity of the League of Friends, and the Royal Voluntary Service. In recent years it has benefitted the Edinburgh Headway Group, ECAS [which assists the disabled], Handicabs and the Kidzcare children’s nursery.

The Future: What the NHS will leave.

The Land

David Ainslie’s bequest returned to us the central part of the green corridor, originally the old Borough Muir and known as the city’s Common Good. This corridor stretches south from the Meadows, through Bruntsfield Links into the Astley Ainslie, onto Blackford Hill and the Braidburn Valley Park and out into the Pentland Hills.

As Walter Scott predicted two hundred years ago, the land now contains an impressive number and range of trees, which were officially assessed and listed in 1998. There are 67 different kinds from all over the world, in total more than 1700 trees (excluding the spruce plantation on the south edge). The City’s report, by R H Watson, accounts for: ‘a good number of very fine specimens, some are among the finest in Edinburgh’. The City’s Development Brief (2002) defines it as, ‘the most extensive and complete Victorian urban treescape left in South Edinburgh.’ The comparative place in the north of the city is the Royal Botanic Gardens, so this is highly significant.

From the early nineteenth century, the industrial revolution alienated the people from the land. Our knowledge and experience of nature is now slender. We need to recreate the understanding that we are only a part of nature and that we are wholly dependent upon it for our lives and survival. This landscape, which is still essentially green, is an oasis. The trees provide the oxygen, which we need to breathe, and filter much of the pollution filling our atmosphere. They balance and contain the water we need from the rain and underground water table. They stabilise the land, and provide an environment for other essential life forms. They are important to our health and happiness.

The land, and the life it supports, is surrounded by a much increased human population of all ages. It is within walking distance of large numbers of people, and easily reached by public transport; it is accessible to the disabled and to small children.

It can be used for education in its wide sense, to allow the young to make intelligent decisions about the future, to allow people to understand and look further into the extraordinary complexity of nature. Developed as a sophisticated garden, it could work with the NHS, the RBGE, the Forestry Commission, Historic Environment, the Universities, care homes, the schools, and individuals who are interested in gardening and natural food. It could accommodate a modern physic garden, greenhouses, allotments, places to walk and places to sit, wild areas.

The Buildings

The Astley Ainslie ground contains the site of the St Roque Chapel and its cemetery; a strong group of listed buildings from the nineteenth and twentieth century; and other hospital buildings put up between the 1920s and the 21st century. Most of these require and deserve upgrading and re-use.